| NPI | 1225368632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN M JOHNSON Managing Member 208-664-4940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: ID M-7963) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2013-03-20 |